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Are Analogue Insulins Superior to Human Insulin in Clinical Practice?

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Abstract

Insulin analogues were designed to provide more physiologic pharmacokinetic and pharmacodynamic properties compared with human insulin. This article examines the literature over a 2-year period, focusing on studies directly comparing analogue and human insulin in controlled clinical trials and large observational studies documenting the introduction of, or change to, analogue insulin in clinical practice. Findings indicate that analogues provide objective benefits that include improved glycemic control, lower risk of hypoglycemia, lower glucose variability, and (for insulin detemir) reduced weight gain. Recent data with analogues also explore their safety and efficacy in special patient groups such as children and adolescents. These data complement increasing evidence that analogues offer improved acceptability and accessibility to people with diabetes.

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Abbreviations

ACTION:

Achieving control through insulin plus oral agents

IMPROVE:

Observational study of safety and effectiveness of NovoMix 30 for the treatment of diabetes mellitus

PREDICTIVE:

Observational, safety study in subjects using Levemir® (Insulin detemir) for the treatment of insulin dependent type 1 or type 2 diabetes mellitus

PRESENT:

Physicians’ routine evaluation of safety and efficacy of NovoMix 30 therapy

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Heller S, Kozlovski P, Kurtzhals P: Insulin’s 85th anniversary—An enduring medical miracle. Diabetes Res Clin Pract 2007, 78:149–158. This paper describes the background of insulin.

  2. Gough SC: A review of human and analogue insulin trials. Diabetes Res Clin Pract 2007, 77:1–15.

    Article  PubMed  CAS  Google Scholar 

  3. Hirsch IB: Insulin analogues. N Engl J Med 2005, 352:174–183.

    Article  PubMed  CAS  Google Scholar 

  4. Brunner G, Hirschberger S, Sendlhofer G: Postprandial administration of the insulin analogue insulin aspart in patients with type 1 diabetes mellitus. Diabet Med 2000, 17:371–375.

    Article  PubMed  CAS  Google Scholar 

  5. • Freeman JS: Insulin analog therapy: improving the match with physiologic insulin secretion. J Am Osteopath Assoc 2009, 109:26–36. This is a review of earlier literature with insulin analogues.

    Google Scholar 

  6. •• Bartley PC, Bogoev M, Larsen J, Philotheou A: Long-term efficacy and safety of insulin detemir compared to Neutral Protamine Hagedorn insulin in patients with type 1 diabetes using a treat-to-target basal-bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trial. Diabet Med 2008, 25:442–449. This is a long-term study in a large cohort of T1D patients showing the best evidence for durable difference between analogue and human insulin.

  7. Hassan K, Rodriguez LM, Johnson SE, et al.: A randomized, controlled trial comparing twice-a-day insulin glargine mixed with rapid-acting insulin analogs versus standard neutral protamine Hagedorn (NPH) therapy in newly diagnosed type 1 diabetes. Pediatrics 2008, 121:e466–e472.

    Article  PubMed  Google Scholar 

  8. • Chase HP, Arslanian S, White NH, Tamborlane WV: Insulin glargine versus intermediate-acting insulin as the basal component of multiple daily injection regimens for adolescents with type 1 diabetes mellitus. J Pediatr 2008, 153:547–553. This paper provides documentation of the use of basal insulin analogue use in children in a large cohort with a separately reported continuous glucose monitoring system substudy.

  9. White NH, Chase HP, Arslanian S, Tamborlane WV: Comparison of glycemic variability associated with insulin glargine and intermediate-acting insulin when used as the basal component of multiple daily injections for adolescents with type 1 diabetes. Diabetes Care 2009, 32:387–393.

    Article  PubMed  CAS  Google Scholar 

  10. De Mattia G, Laurenti O, Moretti A: Comparison of glycaemic control in patients with type 2 diabetes on basal insulin and fixed combination oral antidiabetic treatment: results of a pilot study. Acta Diabetol 2009, 46:67–73.

    Article  PubMed  CAS  Google Scholar 

  11. Bolli GB, Songini M, Trovati M, et al.: Lower fasting blood glucose, glucose variability and nocturnal hypoglycaemia with glargine vs NPH basal insulin in subjects with type 1 diabetes. Nutr Metab Cardiovasc Dis 2009, 19:571–579.

    Article  PubMed  CAS  Google Scholar 

  12. • Fajardo Montañana C, Hernández Herrero C, Rivas Fernández M: Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight type 2 diabetes patients: the PREDICTIVE BMI clinical trial. Diabet Med 2008, 25:916–923. This is a comparison of analogue and human basal insulins with evidence for lower weight gain with insulin detemir.

  13. Davies MJ, Derezinski T, Pedersen CB, Clauson P: Reduced weight gain with insulin detemir compared to NPH insulin is not explained by a reduction in hypoglycemia. Diabetes Technol Ther 2008, 10:273–277.

    Article  PubMed  CAS  Google Scholar 

  14. Sharplin P, Gordon J, Peters JR, et al.: Improved glycaemic control by switching from insulin NPH to insulin glargine: a retrospective observational study. Cardiovasc Diabetol 2009, 8:3.

    Article  PubMed  CAS  Google Scholar 

  15. •• Sreenan S, Virkamäki A, Zhang K, Hansen JB: Switching from NPH insulin to once-daily insulin detemir in basal-bolus-treated patients with diabetes mellitus: data from the European cohort of the PREDICTIVE study. Int J Clin Pract 2008, 62:1971–1980. This shows data from a very large observational study, complementing data from randomized controlled trials with real-life data from an unselected population.

  16. Meneghini LF, Dornhorst A, Sreenan S: Once-daily insulin detemir in a cohort of insulin-naïve patients with type 2 diabetes: a sub-analysis from the PREDICTIVE study. Curr Med Res Opin 2009, 25:1029–1035.

    Article  PubMed  CAS  Google Scholar 

  17. Preumont V, Buysschaert M, De Beukelaer S, Mathieu C: Insulin detemir in routine clinical practice: a 26-week follow-up in type 1 diabetic patients from the Belgian PREDICTIVE Cohort. Acta Clin Belg 2009, 64:49–55.

    PubMed  CAS  Google Scholar 

  18. Schiel R, Müller UA: Efficacy and treatment satisfaction of once-daily insulin glargine plus one or two oral antidiabetic agents versus continuing premixed human insulin in patients with type 2 diabetes previously on long-term conventional insulin therapy: the Switch pilot study. Exp Clin Endocrinol Diabetes 2007, 115:627–633.

    Article  PubMed  CAS  Google Scholar 

  19. • Ashwell SG, Bradley C, Stephens JW, et al.: Treatment satisfaction and quality of life with insulin glargine plus insulin lispro compared with NPH insulin plus unmodified human insulin in individuals with type 1 diabetes. Diabetes Care 2008, 31:1112–1117. This is a crossover study comparing all-analogue with all-human insulin regimens, demonstrating greater patient satisfaction and QoL with analogue insulin therapy.

  20. • Hod M, Damm P, Kaaja R, et al.: Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Insulin Aspart Pregnancy Study Group. Am J Obstet Gynecol 2008, 198:186.e1–e7. This shows documentation of use of rapid-acting insulin analogue use in pregnancy.

  21. Lind M, Fahlén M, Happich M, et al.: The effect of insulin lispro on glycemic control in a large patient cohort. Diabetes Technol Ther 2009, 11:51–56.

    Article  PubMed  CAS  Google Scholar 

  22. Raz I, Wilson PW, Strojek K, et al.: Effects of prandial versus fasting glycemia on cardiovascular outcomes in type 2 diabetes: the HEART2D trial. Diabetes Care 2009, 32:381–386.

    Article  PubMed  CAS  Google Scholar 

  23. •• Velojic-Golubovic M, Mikic D, Pesic M, et al.: Biphasic insulin aspart 30: better glycemic control than with premixed human insulin 30 in obese patients with type 2 diabetes. J Endocrinol Invest 2009, 32:23–27. This is a direct randomized controlled trial comparison of analogue and human premixed insulins.

  24. Clements MR, Tits J, Kinsley BT, et al.: Improved glycaemic control of thrice-daily biphasic insulin aspart compared with twice-daily biphasic human insulin; a randomized, open-label trial in patients with type 1 or type 2 diabetes. Diabetes Obes Metab 2008, 10:229–237.

    Article  PubMed  CAS  Google Scholar 

  25. Liebl A, Prager R, Binz K, et al.: Comparison of insulin analogue regimens in people with type 2 diabetes mellitus in the PREFER study: a randomized controlled trial. Diabetes Obes Metab 2009, 11:45–52.

    Article  PubMed  CAS  Google Scholar 

  26. Masuda H, Sakamoto M, Irie J, et al.: Comparison of twice-daily injections of biphasic insulin lispro and basal-bolus therapy: glycaemic control and quality-of-life of insulin-naïve type 2 diabetic patients. Diabetes Obes Metab 2008, 10:1261–1265.

    PubMed  CAS  Google Scholar 

  27. •• Valensi P, Benroubi M, Borzi V: Initiating insulin therapy with, or switching existing insulin therapy to, biphasic insulin aspart 30/70 (NovoMix 30) in routine care: safety and effectiveness in patients with type 2 diabetes in the IMPROVE observational study. Int J Clin Pract 2009, 63:522–531. This shows data from a very large observational study, complementing data from randomized controlled trials with real-life data from an unselected population.

  28. Shah S, Benroubi M, Borzi V: Safety and effectiveness of biphasic insulin aspart 30/70 (NovoMix 30) when switching from human premix insulin in patients with type 2 diabetes: subgroup analysis from the 6-month IMPROVE observational study. Int J Clin Pract 2009, 63:574–582.

    Article  PubMed  CAS  Google Scholar 

  29. Gao Y, Guo XH, Vaz JA: Biphasic insulin aspart 30 treatment improves glycaemic control in patients with type 2 diabetes in a clinical practice setting: Chinese PRESENT study. Diabetes Obes Metab 2009, 11:33–40.

    Article  PubMed  CAS  Google Scholar 

  30. Jang HC, Lee SR, Vaz JA: Biphasic insulin aspart 30 in the treatment of elderly patients with type 2 diabetes: a subgroup analysis of the PRESENT Korea NovoMix study. Diabetes Obes Metab 2009, 11:20–26.

    Article  PubMed  CAS  Google Scholar 

  31. Sharma SK, Joshi SR, Kumar A, et al.: Efficacy, safety and acceptability of biphasic insulin aspart 30 in Indian patients with type 2 diabetes: results from the PRESENT study. J Assoc Physicians India 2008, 56:859–863.

    PubMed  CAS  Google Scholar 

  32. Rodbard HW, Jellinger PS, Davidson JA, et al.: Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract 2009, 15:540–559.

    PubMed  Google Scholar 

  33. Raskin P, Matfin G, Schwartz SL, et al.: Addition of biphasic insulin aspart 30 to optimized metformin and pioglitazone treatment of type 2 diabetes mellitus: the ACTION Study (Achieving Control Through Insulin plus Oral ageNts). Diabetes Obes Metab 2009, 11:27–32.

    Article  PubMed  CAS  Google Scholar 

  34. Yoshioka N, Kurihara Y, Manda N, et al.: Step-up therapy with biphasic insulin aspart-70/30—Sapporo 1-2-3 study. Diabetes Res Clin Pract 2009, 85:47–52.

    Article  PubMed  CAS  Google Scholar 

  35. •• Blonde L, Merilainen M, Karwe V, Raskin P: Patient-directed titration for achieving glycaemic goals using a once-daily basal insulin analogue: an assessment of two different fasting glucose targets—the TITRATE study. Diabetes Obes Metab 2009, 11:623–631. This is a demonstration of potential of analogue insulins for safe self-titration even to aggressive glycemic targets.

  36. Oyer DS, Shepherd MD, Coulter FC, et al.: A(1c) control in a primary care setting: self-titrating an insulin analog pre-mix (INITIATEplus trial). Am J Med 2009, 122:1043–1049.

    Article  PubMed  CAS  Google Scholar 

  37. Holman RR, Farmer AJ, Davies MJ, et al.: Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med 2009, 361:1736–1747.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The author takes full responsibility for this manuscript. Editorial assistance was provided by Watermeadow Medical, funded by Novo Nordisk, Inc.

Disclosure

Dr. Jeffrey S. Freeman has served on the speakers’ bureau for GlaxoSmithKline, Novartis International AG, NovoNordisk, and Sanofi-Aventis USA, and has received grants and research support from AstraZeneca Pharmaceuticals LP and Bristol-Myers Squibb Company.

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Correspondence to Jeffrey S. Freeman.

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Freeman, J.S. Are Analogue Insulins Superior to Human Insulin in Clinical Practice?. Curr Diab Rep 10, 176–183 (2010). https://doi.org/10.1007/s11892-010-0104-8

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